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General NPI Number Information
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NPI Number | 1184546087
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Entity Type | Individual
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Provider Name | OLIVIA ANNE LARSEN ATC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 6165 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8613
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Country | US
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Telephone | 208-302-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 9393 W BEACON LIGHT RD
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City | STAR
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State | ID
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Zip | 83669-5109
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Country | US
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Telephone | 208-971-9592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | NULL
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